Second re-irradiation: a narrative review of the available clinical data

Nieder, Carsten; Langendijk, Johannes A.; Gückenberger, Matthias; Grosu, Anca L.

doi:10.1080/0284186x.2017.1409433

Cited by 15 publications

(17 citation statements)

References 42 publications

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“…Given that symptomatic improvement, e.g., of bone pain, often is transient, several radiation oncology providers have started to offer a second re-irradiation to selected patients [ 13 ]. A recent review of the available evidence identified a limited number of studies, all with retrospective design [ 14 ]. Despite several limitations, the published data suggest the feasibility and safety of repeated re-irradiation for several, but not all anatomic locations.…”

Section: Introductionmentioning

confidence: 99%

Second Re-irradiation: Clinical Examples of Worthwhile Treatment

Nieder

Yobuta

Mannsåker

2018

Cureus

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Introduction: Improved treatment approaches have resulted in longer survival of patients with certain types of incurable cancer, without eliminating the need for symptom palliation and supportive measures. In this context, re-irradiation is an increasingly important option. Little data exists about a second or repeat re-irradiation.Methods: From a single institution database, patients who received a second re-irradiation with cumulative equivalent doses (equivalent dose in 2-Gy fractions (EQD2) for late effects, alpha/beta-value 3 Gy) of more than 90 Gy and survived for more than six months were identified. Illustrative clinical examples were provided.Results: The examples describe the treatment of sacral bone metastases, recurrent rectal cancer, and pelvic lymph node metastases. The maximum cumulative EQD2 was 142 Gy. Symptomatic responses were obtained without clinically relevant side effects.Conclusion: These three cases illustrate that a second re-irradiation has the potential to provide worthwhile palliative effects without causing overt late toxicity during the remaining life time. In patients who tolerated previous radiotherapy well, further re-irradiation may contribute to the ever-increasing armamentarium of options that increase the survival of patients with incurable cancer and try to prolong the time period where independent living is possible.

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Section: Introductionmentioning

confidence: 99%

Second Re-irradiation: Clinical Examples of Worthwhile Treatment

Nieder

Yobuta

Mannsåker

2018

Cureus

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“…No case of head and neck re‐RT was reported in that review. In a historical report originating from the 1930s, 3 patients were irradiated between 3 and 5 times for laryngeal carcinoma recurrence, but all of them developed fatal complications associated with the treatment . Despite this exception, no other cases of a third re‐irradiation course for a locally recurrent head and neck cancer have been published before, especially no cases without severe adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…Although re‐RT is an emerging field in radiation oncology, data on second re‐RT, regardless of the localization, are rarely available. A recent review by Nieder et al found 9 series about a second re‐RT, each including between 2 and 25 patients. Re‐re‐irradiated regions were central nervous system, lung, bones, and pelvis.…”

Section: Discussionmentioning

confidence: 99%

“…In a historical report originating from the 1930s, 3 patients were irradiated between 3 and 5 times for laryngeal carcinoma recurrence, but all of them developed fatal complications associated with the treatment. 27 Despite this exception, no other cases of a third re-irradiation course for a locally recurrent head and neck cancer have been published before, especially no cases without severe adverse events. Nowadays, it remains difficult to define a "maximum tolerable lifetime dose or irradiation" for patients with head and neck cancer, as such limitations depend on individual factors like irradiated volume, time-interval between RT-courses and proximity, and tolerance and repair of OAR.…”

Section: Casementioning

confidence: 99%

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Second infield re‐irradiation with a resulting cumulative equivalent dose (EQD2_max) of >180 Gy for patients with recurrent head and neck cancer

et al. 2018

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Background For locally recurrent head and neck cancer, re‐irradiation with modern techniques like stereotactic body radiotherapy is a promising, possibly curative alternative to palliative systemic therapy. Methods We report on 1 patient with nasopharyngeal carcinoma (NPC) and 1 patient with cutaneous squamous cell carcinoma (SCC). Both patients received full dose primary treatment (>66 Gy, EQD2), full dose re‐irradiation (>50 Gy, EQD2), and a second course of re‐irradiation via robotic radiosurgery (CyberKnife) for a second local recurrence. Results Both treatments resulted in adequate tumor response. No grade III‐IV acute or late toxicities occurred. Follow‐up at 6 months after third irradiation showed partial remission for the patient with NPC. In the second case (SCC), no toxicities occurred and the tumor was in remission 18 months after last treatment. Conclusion These cases show that a second course of re‐irradiation utilizing modern techniques like robotic radiosurgery might be feasible for carefully selected patients with head and neck cancer.

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“…Therefore, re-irradiation with curative intent is challenging. In fact, to date, previous re-irradiation was mostly performed as a palliative treatment (3, 4).…”

Section: Introductionmentioning

confidence: 99%

Prospective Study of Isolated Recurrent Tumor Re-irradiation With Carbon-Ion Beams

et al. 2019

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Purpose: To perform a prospective study to evaluate the efficacy and safety of isolated recurrent tumor re-irradiation with carbon-ion radiotherapy (RT). Methods and Materials: The inclusion criteria were clinically proven recurrent tumors, measurable by computed tomography or magnetic resonance imaging, patients ≥ 16 years old, performance status scores between 0 and 2, isolated tumor at a previously irradiated site, and a life expectancy > 6 months. The exclusion criteria were tumor invasion into the gastrointestinal tract or a major blood vessel, uncontrolled infection, early recurrence (<3 months), and severe concomitant diseases. The primary end-point was the local control rate, the secondary end-points including the overall survival rate, and adverse events. Results: Between December 2013 and March 2016, 22 patients were enrolled in this prospective study. All patients were re-irradiated with carbon-ion RT with radical intent. Five patients had rectal cancer, 4 had sarcoma, 4 had lung cancer, 3 had hepatic cell carcinoma, and 6 had other tumors. The median follow-up time was 26 months. Eight patients developed local recurrence, and the 1- and 2-year local control rates were 71 and 60%, respectively. Eight patients died of their cancers and 2 died of other diseases. The 1- and 2-year overall survival rates were 76 and 67%, respectively. There were no grade 2 or higher acute adverse events and 4 patients (18%) developed grade 3 late adverse events. The group with the longer interval (>16 months) between the first RT and re-irradiation had significantly better outcomes than the shorter interval group (≤ 16 months). Conclusions: Re-irradiation, using carbon-ion RT with radical intent, had favorable local control and overall survival rates without severe toxicities for selected patients. Re-irradiation has the potential to improve clinical outcomes for isolated, local, recurrent tumors; further investigations are required to confirm the therapeutic efficacy.

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Second re-irradiation: a narrative review of the available clinical data

Cited by 15 publications

References 42 publications

Second Re-irradiation: Clinical Examples of Worthwhile Treatment

Second Re-irradiation: Clinical Examples of Worthwhile Treatment

Second infield re‐irradiation with a resulting cumulative equivalent dose (EQD2_max) of >180 Gy for patients with recurrent head and neck cancer

Prospective Study of Isolated Recurrent Tumor Re-irradiation With Carbon-Ion Beams

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Second re-irradiation: a narrative review of the available clinical data

Cited by 15 publications

References 42 publications

Second Re-irradiation: Clinical Examples of Worthwhile Treatment

Second Re-irradiation: Clinical Examples of Worthwhile Treatment

Second infield re‐irradiation with a resulting cumulative equivalent dose (EQD2max) of >180 Gy for patients with recurrent head and neck cancer

Prospective Study of Isolated Recurrent Tumor Re-irradiation With Carbon-Ion Beams

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Second infield re‐irradiation with a resulting cumulative equivalent dose (EQD2_max) of >180 Gy for patients with recurrent head and neck cancer